By Marvin Ross, Guest Columnist 

In typical government fashion, the Canadian Chronic Pain Task Force continues to delay taking a stand on the plight of pain patients by initiating a new survey, while still blaming doctors and patients for the opioid crisis. 

The Task Force was established last year to help Health Canada better understand the needs of chronic pain patients. Their preliminary report in June found that anxiety and fear about opioids were causing pain to go untreated:

“Some Canadians have been unable to access opioid medications when needed for pain and function. Others have faced undue barriers to obtaining or filling their opioid prescriptions, and some have had their opioid dose abruptly lowered or discontinued. This has resulted in unnecessary pain and suffering, and has led some Canadians to obtain illegal drugs to treat their pain. We must do more to strike the right balance – to promote opioid prescribing practices that balance the benefits and risks of these medications based on the individual needs of each patient.”

Those initial findings were consistent with the results of a survey of over 700 pain patients conducted by the Chronic Pain Association of Canada (CPAC). That survey found that nearly half of Canadian patients had their pain medication reduced, many were in much greater pain, had severely diminished quality of life, lost doctors or had poor relations with them, attempted suicide or turned to street drugs for help.

At that point, the Task Force response should have been to make recommendations to reverse those negative impacts on patients. Two evaluations that replicate each other should be sufficient to take action to relieve the suffering caused by Canada’s 2017 opioid prescribing guideline.

But that is apparently asking too much as they've decided to do another survey through invitations to their online questionnaire. These are the key questions: 

• What challenges and barriers to understanding, preventing, or managing pain exist in your community and in Canada?  

• What needs to be done to respond to these challenges and barriers? 

• What is working to address pain in your community and in Canada? Please provide specific examples of practices and/or activities. 

• What is it about these practices/activities that makes them successful?  

• What should be the 3 top priorities for research in pain from your point of view?  

• What would help to better integrate research and new knowledge into education and training, policy, clinical practice, and everyday life?  

• What other strategies would help us to better understand, prevent, and/or manage pain in Canada?

Well, the main barrier to managing pain is the adherence by doctors to the prescribing guideline and their fear of losing their medical licenses if they don’t. Nothing will restore functioning to those impacted without rescinding that. The rest of the questions are inane. 

Where Is the Evidence?

As I pointed out in an earlier PNN article, Health Canada implemented the guideline based on weak evidence that the increase in opioid deaths result from inappropriate prescribing by doctors and misuse by patients. PNN columnist Ann Marie Gaudon attempted to obtain the research that Health Canada used to justify their claims and it was like pulling teeth, as you’ll see in this phone call. 

When the research was finally obtained, it didn’t prove a link between prescribing and overdoses. When CPAC sent them a critique of their studies, Health Canada replied that they have much more evidence, but then ignored requests for copies. CPAC has submitted a Freedom of Information request and is waiting for a response. 

Health Canada and the Chronic Pain Task Force continue to base their work on the many myths and misperceptions associated with opioid prescribing, which were debunked in a review recently published in Pain Management Nursing.  

A policy based on faulty logic to solve a problem (addiction and opioid overdoses) caused a new problem by condemning innocent people to unnecessary pain and suffering. Meanwhile, the original problem only grows worse. It is time to go back to the drawing board and accept what every Sociology 101 student knows. There are unintended consequences. Until that happens, nothing will be improved for anyone.   

But then, to make matters worse, this week Health Canada announced nearly $3 million in funding “to help people living with chronic pain.” Most of the money will apparently be spent on treating and preventing addiction, not treating pain. Saskatchewan will get $1.7 million from the Substance Use and Addictions Program and Alberta will get $1.2 million to “improve care delivery including opioid prescribing practices.” 

Health Canada does not seem to be able to distinguish between people with chronic pain and those with substance abuse problems. They are not the same and it is insulting to combine them. It is time that Health Canada learned to distinguish between dependence and addiction. 

Marvin Ross is a medical writer and publisher in Dundas, Ontario.